Memorandum by the Catholic Union of Great
Britain and the Guild of Catholic Doctors
The Joint Ethico-Medical Committee is composed
of members drawn from the two parent bodies. The Catholic Union
is an organisation of the Catholic laity which is not affiliated
to the hierarchy but which represents the Catholic viewpoint,
where relevant, in Parliamentary and legislative matters. The
Guild of Catholic Doctors represents Catholic Medical Practitioners
in the United Kingdom.
GENERAL COMMENTS
Euthanasia, as understood by the Catholic Church,
is an act or omission which of itself or intention causes death
with the purpose of eliminating suffering. Euthanasia's terms
of reference, therefore, are to be found in the intention of the
will and in the methods used. Assisted suicide is included in
the definition of euthanasia.
It is noteworthy that the definition of "assisted
dying" given in clause 1(2) includes direct killing, ie direct
euthanasia, of those unable to commit suicide. It is dishonest
to give the bill a title of "assisted dying", when it
is intended to allow direct euthanasia.
It is a reality that we will all die. Modern
medicine has allowed most of us to live into old age, but there
will come a point, whether by direct illness or by the frailty
due to the degenerative process of old age, when death will be
inevitable. Many accuse those who feel strongly about the sanctity
of life of requiring that everything must be done to keep patients
alive at all costs. This has never been a position adopted by
the Catholic Church. We accept that medical procedures, which
are disproportionate to any expected results or which impose an
excessive burden on the patient and his family, can be refused
or withdrawn so long as the normal care due to the sick person
is not interrupted.
The Church has always taught that man has free
will; that is the freedom to choose between what is right and
what is wrong. In secular understanding free will is frequently
translated as personal autonomy. However personal autonomy is
not absolute. The nature of man is that we live in relationships
with one another. Our actions and choices in many ways have an
effect on others. Suicide by an individual affects others in many
ways. This fact was recognised by the Supreme Court of America,
in its memorable and rare unanimous decision of 26 June 1997,
where it held that the US Constitution did not protect the right
to suicide. It manifested a particular sensitivity to the fact
that rarely are all those facing disability or terminal illness
in equivalent situations. It said "The State's interest
goes beyond protecting the vulnerable from coercion; it extends
to protecting disabled and terminally ill people from prejudice,
negative and inaccurate stereotypes, and sociological indifference".
This Bill implies we are totally autonomous
individuals and that our real value lies in our ability to act
and choose. By contrast, the Christian understanding assumes we
are essentially not isolated individuals but persons in relationships.
Indeed we are persons only in and through our relationships with
other persons. Our ability to relate to and act in support of
others is part of our very humanity. Appropriate medical care,
supported by the moral teaching of the Christian churches, urges
that life does not have to be prolonged at all costs. Individuals
who competently choose to commit suicide are not legally prohibited
from doing so. In respecting the freedom of an individual to commit
suicide the physician has no duty to assist them. To do so would
destroy the solidarity which the medical profession should have
with its patients, offering them care and support during their
times of difficulty.
Some years ago the Roman Catholic and Anglican
Churches submitted a joint statement to the House of Lords Select
Committee on this subject; "Neither of our churches insists
that a dying or seriously ill patient should be kept alive by
all possible means for as long as possible. On the other hand,
we don't believe that the right to personal autonomy is absolute.
It is valid only when it recognises other moral values, especially
the respect to human life as such whether someone else's or not."
There is little evidence of demand from doctors
for legalisation of euthanasia. The most recent large survey was
done by Doctors.net, regarded as the foremost medical Internet
company in the UK. 986 medical practitioners completed it over
a two-week period from 26 March to 9 April 2003. A total of 9,000
doctors were approached over this period, selected at random,
and the company was assured that an 11 per cent response rate
was typical of this type of Internet study. It revealed that a
majority of doctors are not in favour of either euthanasia (61
per cent) or assisted suicide (60 per cent). Only 22 per cent
of doctors were in favour of euthanasia and only 25 per cent were
in favour of assisted suicide. A significant number (13 per cent)
were undecided, mainly because they were not directly involved
in the decision-making process. Most doctors would refuse to perform
either euthanasia (76 per cent) or assisted suicide (74 per cent)
if it were legalised.
The case for the decriminalisation of euthanasia
has been reduced by the success of the hospice movement. 98 per
cent of terminal pain can now be relieved. The emphasis of the
proponents of euthanasia and assisted suicide has therefore shifted
to the other forms of suffering experienced by some at the end
of life. Surveys have shown that most people who request assisted
suicide are lonely and not always terminally ill. (New England
Journal of Medicine 1999: 340; 577-583.)
We have seen in the Dianne Pretty judgement
in 2003, that there is no "right to die", least of all
at the hand of another. All the judges were unanimous, at appeal,
in the House of Lords and in Strasbourg, in denying the applicant's
request that her husband be not prosecuted for assisting her suicide.
Their reasons are voluminous and we trust that the Select Committee
will review them.
SPECIFIC COMMENTS
Opening paragraph
This includes the phrase " . . . and
to make provision for a person suffering from a terminal illness
to receive pain relief medication." Symptom relief is
part of normal medical care, and has been since medicine was first
practised in ancient times. Its inclusion in this Bill implies
that doctors are being negligent in not providing adequate care.
There is absolutely no need for such a phrase to appear in any
new legislation, and especially not in any legislation relating
to euthanasia.
Clause 2 (Qualifying conditions)
Prognosis is not an exact science and there
can be no such certainty regarding prognosis as the Bill presumes.
Even diagnosis can be uncertain, as has been shown repeatedly
in post mortem studies worldwide, where the cause of death given
on the death certificate was found to be incorrect in around 25
per cent of cases.
Unbearable suffering cannot be objectively assessed
and is therefore a subjective assessment. Furthermore acceptance
by a physician that suffering is unbearable and sufficient to
warrant euthanasia is tacit recognition that a patient's life
is no longer of value. Such value judgements of the worthiness
of an individual's life will do great harm to the relationship
of trust and caring that must exist between patients and their
doctors.
Clause 3 (Offer of palliative care)
We are not persuaded that bona fide professionals
in the field of palliative care would undertake the tasks envisioned,
given that one outcome is the antithesis of their ethic. Last
year the World Medical Association in its Washington conference
advised all doctors to avoid co-operating with euthanasia, even
in jurisdictions where it is legal.
Clause 4 (Declarations made in advance)
Despite the conditions, there is no way to ascertain
that the patient is making the request freely and that they are
not being coerced to do so by relatives or others. The medical
profession can experience difficulty assessing a patient's mental
state, so how is a solicitor to determine that a patient is of
sound mind?
Clause 7 (Duties of physicians, and conscientious
objection)
This clause, despite its wording, does not grant
conscientious objection. It is recognised in law that a person
who commissions another to commit a crime is not innocent but
guilty by their complicity. So it is morally. A person who cannot
perform an act, but passes the patient onto others in the knowledge
that they will perform the act is morally equally culpable of
that act. Those who hold convictions about the immorality of euthanasia
will be unable to comply with this Act as they will not be able,
in conscience, to refer the patient onto other willing physicians.
To refer a patient to another physician for euthanasia would be
acting against one's conscience. The right to practise in accordance
with one's conscience or religious belief is protected under article
9 of the Human Rights Act.
Clause 8 (Psychiatric referral)
A single psychiatrist cannot resolve the question
of competence, in the manner suggested. The Mental Capacity
Bill makes this abundantly clear. Capacity varies with time
and the nature of decision under consideration.
Clause 10 (Protection for physicians and other
medical personnel)
We read this whole section with great anxiety
as it seeks to protect medical teams and doctors rather than the
patient. It is the complete reverse of current good practice.
It would in many ways put the doctor outside legal control. We
fear that this is one of the purposes of the whole Bill, to protect
the doctor and not the patient.
Clause 11 (Offences)
Given the other weaknesses in the Bill, we are
not convinced that these provisions are as protective as they
seem, for example diagnosis and prognosis are notoriously difficult,
and assessment of the unbearability of suffering is subjective.
What are the criteria to be used for judging that a declaration
was false? As we have seen with the 1967 Abortion Act doctors
"acting in good faith" can lead to almost any falsification.
Who really believes that the 180,000 women who annually have abortions
on psychiatric grounds were suffering from the stated depression
or neurotic illness given as the medical reason for their abortions?
Clause 15 (Administration of drugs to patients
suffering severe distress)
This clause is completely unnecessary. Not only
is this practice lawful, it is standard medical practice for doctors
to ask their patients about pain and distress, and give appropriate
medication.
Clause 16
The powers given to the Secretary of State to
make regulations would give scope for far reaching variations,
well beyond the intentions of Parliament. As the outcome of changes
to such regulations will control the outcome of death for individuals,
it is inappropriate that any such changes should be exercised
by Statutory Instrument. The reality is that any changes would
be recommendations of an appointed unelected commission, all of
whom would favour euthanasia.
CONCLUSION
We sincerely hope that the Committee will examine
the reasons put forward, by the House of Lords Select Committee
on Medical Ethics in 1994, against euthanasia and reach the same
conclusion. The conclusions of the 1994 report of the House of
Lord Select Committee on Medical Ethics are equally valid today
as then.
2 September 2004
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